Healthcare Provider Details

I. General information

NPI: 1114449972
Provider Name (Legal Business Name): ONE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 AMPHITHEATRE PKWY
MOUNTAIN VIEW CA
94043-1351
US

IV. Provider business mailing address

1 EMBARCADERO CTR STE 1900
SAN FRANCISCO CA
94111-3723
US

V. Phone/Fax

Practice location:
  • Phone: 650-227-1102
  • Fax: 650-227-1107
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-520-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW DIAMOND
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: MD
Phone: 415-658-6791